Category: language delay

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Have you Worked on Morphological Awareness Lately?

Last year an esteemed colleague, Dr. Roseberry-McKibbin posed this question in our Bilingual SLPs Facebook Group:  “Is anyone working on morphological awareness in therapy with ELLs (English Language Learners) with language disorders?”

Her question got me thinking: “How much time do I spend on treating morphological awareness in therapy with monolingual and bilingual language disordered clients?” The answer did not make me happy!

So what is morphological awareness and why is it important to address when treating monolingual and bilingual  language impaired students?

Morphemes are the smallest units of language that carry meaning. They can be free (stand alone words such as ‘fair’, ‘toy’, or ‘pretty’) or bound (containing prefixes and suffixes that change word meanings – ‘unfair’ or ‘prettier’).

Morphological awareness refers to a ‘‘conscious awareness of the morphemic structure of words and the ability to reflect on and manipulate that structure’’ (Carlisle, 1995, p. 194). Also referred to as “the study of word structure” (Carlisle, 2004), it is an ability to recognize, understand, and use affixes or word parts (prefixes, suffixes, etc) that “carry significance” when speaking as well as during reading tasks. It is a hugely important skill for building vocabulary, reading fluency and comprehension as well as spelling (Apel & Lawrence, 2011; Carlisle, 2000; Binder & Borecki, 2007; Green, 2009). 

So why is teaching morphological awareness important? Let’s take a look at some research.

Goodwin and Ahn (2010) found morphological awareness instruction to be particularly effective for children with speech, language, and/or literacy deficits. After reviewing 22 studies Bowers et al. (2010) found the most lasting effect of morphological instruction was on readers in early elementary school who struggled with literacy.

Morphological awareness instruction mediates and facilitates vocabulary acquisition leading to improved reading comprehension abilities (Bowers & Kirby, 2010; Carlisle, 2003, 2010; Guo, Roehrig, & Williams, 2011; Tong, Deacon, Kirby, Cain, & Parilla, 2011).

Unfortunately as important morphological instruction is for vocabulary building, reading fluency, reading comprehension, and spelling, it is often overlooked during the school years until it’s way too late. For example, traditionally morphological instruction only beings in late middle school or high school but research actually found that in order to be effective one should actually begin teaching it as early as first grade (Apel & Lawrence, 2011).

So now that we know that we need to target morphological instruction very early in children with language deficits, let’s talk a little bit regarding how morphological awareness can be assessed in language impaired learners.

When it comes to standardized testing, both the Test of Language Development: Intermediate – Fourth Edition (TOLD-I:4) and the Test of Adolescent and Adult Language–Fourth Edition (TOAL-4) have subtests which assess morphology as well as word derivations. However if you do not own either of these tests you can easily create non-standardized tasks to assess  morphological awareness.

Apel, Diehm, & Apel (2013) recommend multiple measures which include:  phonological awareness tasks, word level reading tasks, as well as reading comprehension tasks.

Below are direct examples of tasks from their study:

MATs

One can test morphological awareness via production or decomposition tasks. In a production task a student is asked to supply a missing word, given the root morpheme (e.g., ‘‘Sing. He is a great _____.’’ Correct response: singer).  A decomposition task asks the student to identify the correct root of a given derivation or inflection. (e.g., ‘‘Walker. How slow can she _____?’’ Correct response: walk).

Another way to test morphological awareness is through completing analogy tasks since it involves both  decomposition and production components (provide a missing word based on the presented pattern—crawl: crawled:: fly: ______ (flew).

Still another way to test morphological awareness with older students is through deconstruction tasks: Tell me what ____ word means? How do you know? (The student must explain the meaning of individual morphemes).

Finding the affix: Does the word ______ have smaller parts?

So what are the components of effective morphological instruction you might ask?

Below is an example of a ‘Morphological Awareness Intervention With Kindergarteners and First and Second Grade Students From Low SES Homes’ performed by Apel & Diehm, 2013:

Apel and Diem 2011

Here are more ways in which this can be accomplished with older children:

  • Find the root word in a longer word
  • Fix the affix (an additional element placed at the beginning or end of a root, stem, or word, or in the body of a word, to modify its meaning)
    • Affixes at the beginning of words are called “prefixes”
    • Affixes at the end of words are called “suffixes
  • Word sorts to recognize word families based on morphology or orthography
  • Explicit instruction of syllable types to recognize orthographical patterns
  • Word manipulation through blending and segmenting morphemes to further solidify patterns

Now that you know about the importance of morphological awareness, will you be incorporating it into your speech language sessions? I’d love to know!

Until then, Happy Speeching!

References:

  • Apel, K., & Diehm, E. (2013). Morphological awareness intervention with kindergarteners and first and second grade students from low SES homes: A small efficacy study. Journal of Learning Disabilities.
  • Apel, K., & Lawrence, J. (2011). Contributions of morphological awareness skills to word-level reading and spelling in first-grade children with and without speech sound disorder. Journal of Speech, Language & Hearing Research, 54, 1312–1327.
  • Apel, K., Brimo, D., Diehm, E., & Apel, L. (2013). Morphological awareness intervention with kindergarteners and first and second grade students from low SES homes: A feasibility study. Language, Speech, and Hearing Services in Schools, 44, 161-173.
  • Binder, K. & Borecki, C. (2007). The use of phonological, orthographic, and contextualinformation during reading: a comparison of adults who are learning to read and skilled adult readers. Reading and Writing, 21, 843-858.
  • Bowers, P.N., Kirby, J.R., Deacon, H.S. (2010). The effects of morphological instruction on literacy skills: A systematic review of the literature. Review of Educational Research, 80, 144-179.
  • Carlisle, J. F. (1995). Morphological awareness and early reading achievement. In L. B. Feldman (Ed.), Morphological aspects of language processing (pp. 189–209). Hillsdale, NJ: Erlbaum.
  • Carlisle, J. F. (2000). Awareness of the structure and meaning of morphologically complex words: Impact on reading. Reading and Writing: An Interdisciplinary Journal,12,169-190.
  • Carlisle, J. F. (2004). Morphological processes that influence learning to read. In C. A. Stone, E. R. Silliman, B. J. Ehren, & K. Apel (Eds.), Handbook of language and literacy. NY: Guilford Press.
  • Carlisle, J. F. (2010). An integrative review of the effects of instruction in morphological awareness on literacy achievement. Reading Research Quarterly, 45(4), 464-487.
  • Goodwin, A.P. & Ahn, S. (2010). Annals of Dyslexia, 60, 183-208.
  • Green, L. (2009). Morphology and literacy: Getting our heads in the game. Language, Speech, and Hearing Services in the schools, 40, 283-285.
  • Green, L., & Wolter, J.A. (2011, November). Morphological Awareness Intervention: Techniques for Promoting Language and Literacy Success. A symposium presentation at the annual American Speech Language Hearing Association, San Diego, CA.
  • Guo, Y., Roehrig, A. D., & Williams, R. S. (2011). The relation of morphological awareness and syntactic awareness to adults’ reading comprehension: Is vocabulary knowledge a mediating variable? Journal of Literacy Research, 43, 159-183.
  • Tong, X., Deacon, S. H., Kirby, J. R., Cain, K., & Parrila, R. (2011). Morphological awareness: A key to understanding poor reading comprehension in English. Journal of Educational Psychology, 103 (3), 523-534.
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Preventing Learned Helplessness in Students with Language Impairments

A few weeks ago in one of my private speech language therapy sessions, I was reviewing the homework  of an 11-year-old student,  part of which involved  synonym and  antonym production describing abstract feelings (e.g., disinterested, furious, etc.). These words were in the client’s lexicon as we had been working on the concept of abstract feelings for a number of weeks. I was feeling pretty confident that the student would do well on this assignment, especially because prior to assigning the homework we had identified the exact emotion which required the generation of antonyms and synonyms. So all was going swimmingly,  until she made the following comment when explaining one of her answers: “I was thinking that this word ____ is not really an appropriate synonym for _________ but I put it anyway because I couldn’t think of any others.”

That gave me a pause because I couldn’t quite believe what I was hearing. So I asked: “I completely understand that you might not have remembered some words but what could you have done to help yourself in this situation?” Without any prompting, the student readily identified a number of strategies including: looking up the words in a thesaurus/dictionary, “Googling” them, or even asking an adult to help her with choosing the best answers from a number of choices.

My follow-up question to her was: “Why didn’t you?” The student just shrugged her shoulders and looked at me in surprise, as though this concept had never occurred to her.

This incident got me thinking regarding the pervasive influence of learned helplessness, and how our students continue to be impacted by it long after they begin receiving the necessary therapies to improve their academic performance.

For those of you unfamiliar with this term, here is a brief overview. This phrase was coined by a US based psychologists Martin Seligman and Steven Maier in 1967. In a series of experiments they exposed dogs to electric shocks that they were unable to escape. After a little while the dogs stopped trying to avoid the aversive stimuli because they became conditioned to the fact that they were helpless to change the situation. However, the most fascinating aspect in these series of experiments was the fact that even after the opportunity to escape became clearly available, the animals still failed to take any action and continue to behave as though they were still helpless.

How does this apply to students with learning disabilities? 

Many students with language impairments and learning disabilities struggle significantly in school setting due to failing academic performance. The older they get, the more academic demands are placed on them.  This includes but is not limited to the amount of homework they asked to complete, the number of long-term projects they’re expected to write, as well as the number of tests they are expected to study for.

Because they are unable to meet the ever increasing academic demands, their parents begin to actively micromanage their academic life by scheduling the times when the students are expected to perform homework, study for tests, do projects, and much much more. As a result, many of the students do not know how to do any of the above activities/tasks independently because they are conditioned  by their parents/teachers to tell them what to do, how to do it, and how to lead their academic life at any given moment.

The students begin believing they they are helpless  to change even the most basic situations (e.g., take an extra step during the homework assignment and look up a vocabulary word without anyone telling them to do it) and continue to behave in this fashion long after they begin receiving the necessary therapies, coaching, or in school assistance. This is especially true of students whose language/learning disabilities are not identified until later in their school career (e.g., late elementary years, middle school, or even high school).

What are the Symptoms of Learned Helplessness in Children?  

The below poster from Dragonfly Forest Blogspot/Forest Alliance Coaching summarizes it quite nicely.

Other symptoms of learned helplessness include:

  • Lack of motivation/task initiation
  • Poor critical thinking abilities
  • Reluctance to make independent choices
  • Low self-esteem
  • Depression
  • Blaming a disability: “I act like this because I have _________”

It is important to note that the above symptoms are most applicable to students with learning disabilities and average cognition.  However, learned helplessness is equally pervasive (if not more so) in students with developmental disabilities (e.g., ASD, genetic syndromes, etc.)

Below are just a few examples of learned helplessness in students with developmental disabilities, which were inadvertently (and/or deliberately) reinforced by the adults in their lives(e.g., family members, educational staff, etc.).

  • Spoon feeding a three-year-old with ASD who has already mastered this particular ADL skill
  • Having a non-verbal eight-year-old correctly identify the PECS card for “open” but then always opening the door for him without giving him an opportunity to do so himself
  • Keeping a 12-year-old with ASD on puréed diet despite multiple MBS and FEES studies indicating that there are no structural abnormalities which would prevent this student from successfully trialing solid foods
  • Not placing basic expectations such as cleanup of toys on a verbal seven-year-old with Down Syndrome, simply because of her condition

Changing the Patterns of Learned Behavior:

According to available literature, when psychologists had tried to change learned helplessness in animal subjects it took them between 30 – 50 times of physically moving the dogs across the barrier before they proceeded to do so independently. Thus, it stands to reason that the process of rewiring the brain in humans with learned helplessness will be a lengthy one as well.

The first task on the part of adults  is active analysis of all the things  we may be doing  as  parents and educators,  which inadvertently  reinforces learned helplessness in our children/students.   Some  things may surprise you.   For example, I frequently ask the  parents of the students on my caseload what chores and responsibilities  they give their children at home.   In an overwhelming majority of the cases  my clients have  very few chores/responsibilities at home.  This  is especially apparent in families  of language  impaired children  with typically developing siblings. Conversations with parents  frequently reveal that many typically developing siblings (who are sometimes younger than my clients)  have far greater responsibilities  when it comes to chores,  assignment completion,  etc.

Did you know that an average 8-9 year-old is expected to remember to do chores for 15-20 min after school (“prospective memory”), independently, plan school projects (select book, do report, present in school), keep track of changing daily schedule, do homework for 1 hour independently as well as keep track of personal effects when away from home? (Peters, 2013)

Did you know that an average —12-14 year old is expected to demonstrate adult level planning abilities, have daily chore responsibilities for 60-90 minute in length, babysit younger siblings, follow complex school schedule, as well as plan and carry out multiple large semester-long school projects independently? (Peters, 2013)

While our language impaired children of the same age may not be capable of some of the above responsibilities they are capable of  more then we give them credit for given appropriate level of support (strategies vs. doing things for them).

Where do we begin?

It is important to recognize the potential of the children that we work with without letting their disabilities to color our subjective perceptions of what they can and cannot do. In other words, just because there are significant physical/cognitive handicaps, it does not mean that given appropriate accommodations, therapies, resources, as well as compensatory strategies that our student will not be able to reach their optimal potential.

Working with Physically/Cognitively Impaired Children: 

  • Uphold accountability 
    • You wouldn’t let a typical four-year-old get away with leaving a mess and not cleaning up their toys, so why would you let a four-year-old with Down syndrome or ASD slide?  It might take a tad longer to teach them what to do and how to do it but it certainly is more then doable
  • Do not excuse inappropriate behaviors and attribute it to a disability
  • Assign responsibility
    • Even in the presence of physical and cognitive disabilities students are still capable of performing a number of tasks and chores. This may include but not be limited to cleaning up own room, making up one bed, loading and unloading the dishwasher, taking out the garbage, vacuuming the floor, pushing the grocery cart in the store, loading and unloading food at the cash register, and much much more.
  • Encourage Hobbies 
  • Explore Adapted Sports 
    • Similar to hobbies adaptive sports can be incredibly beneficial to children with developmental disabilities. Movement helps to rewire the brain! Adaptive sports participation increases the child’s independence as well as fosters socialization with others.  Engagement in adaptive sports can also combat learned helplessness.
  • Support Quality of Life Experiences
    • Unfortunately the quality of life of the children with developmental disabilities that we work with is often compromised. Because there is inordinate focus placed on “just existing” and fitting in all the therapies, frequently joyful experiences are few and far between. If the situation allows it needs to change! There are so many simple activities we take for granted, which can bring true happiness to the children that we work with.
      • Swimming in the pool
      • Visiting a museum
      • Going into an amusement park
      • Picking berries or mushrooms in the woods
      • Going to the beach
      • Bird watching
      • Taking a vacation (if financially doable)
  • Expect more
    • Don’t let the child’s cognitive and/or physical limitations  stop them from reaching their true potential.
      • This may mean disagreeing with well-meaning but limitedly knowledgeable school-based professionals, who may tell you that your child with genetic syndrome such as Down Syndrome or Fragile X will never learn how to read (see Case C) 
      • This may mean finding accommodations and compensatory strategies for a student’s severe disabilities to make that person’s life more meaningful and enjoyable.  To illustrate, many years ago when I just started working for a school for severely medically fragile children, I’ve worked with severely physically impaired nonverbal young adult  (21) who had a limited use of his right arm (gross motor movements]only).  That did not stop us from ‘discussing’ works of literature, studying SAT level vocabulary, as well as learning Greek and Latin Roots of English.   It also didn’t stop his parents from exposing him to a variety of life experiences, aimed to make him feel like an average young adult, such as allowing him to taste a few drops of sake even though he was NPO (lat. for nothing by mouth)

Working with Language Impaired and Learning Disabled Children with Average IQ:

  • Increase their accountability in own education
    • Teach useful compensatory strategies
      • Have the children wear a watch to be more mindful of the passage of time (a child 6+ years of age could be an appropriate candidate)
      • Use of schedules, planners, and timers to be more mindful of time spent on homework, assignments, and test studying
      • Use charts listing various strategies of asking for help to teach children to increase ownership of their learning (FREE HERE)
  • Teach them to speak up regarding needed accommodations
    • Use of software applications
    • Time to prepare for oral responses
    • Use of choices when answering questions of increased complexity
    • Audio recording of newly taught information in the classroom
  • Develop their critical thinking skills and problem solving abilities
  • Change your outlook
    • Replace doing everything for them attitude or finger-pointing and blame attitude with solution- focused constructive criticism by teaching specific strategies which will help the student succeed
  • Encourage perseverance
    • Teach the students positive strategies of not giving up and persisting through the difficult situations

Changing the ingrained patterns of learned helplessness is no easy feat.  It requires time, perseverance, and patience. But it can be done even in children with significant developmental and learning disabilities.  It is a difficult but much needed process, which is instrumental in helping our students/children attain their optimal potential.

References:

  1. Seligman, M. E. P. (1975) Helplessness: On Depression, Development, and Death. San Francisco : Freeman.
  2. Peterson, C., S. Maier, and M. Seligman. (1993). Learned Helplessness. New York: Oxford University Press.
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Special Education Disputes and Comprehensive Language Testing: What Parents, Attorneys, and Advocates Need to Know

Image result for evaluationSeveral years after I started my private speech pathology practice, I began performing comprehensive independent speech and language evaluations (IEEs).

For those of you who may be hearing the term IEE for the first time, an Independent Educational Evaluation is “an evaluation conducted by a qualified examiner who is not employed by the public agency responsible for the education of the child in question.” 34 C.F.R. 300.503. IEE’s can evaluate a broad range of functioning outside of cognitive or academic performance and may include neurological, occupational, speech language, or any other type of evaluations  as long as they bear direct impact on the child’s educational performance.

Independent evaluations can be performed for a wide variety of reasons, including but not limited to:

  • To determine the student’s present level of functioning
  • To determine whether the student presents with hidden, previously undiscovered deficits (e.g., executive function, social communication, etc.)
  • To determine whether the student’s educational classification requires a change
  • To determine if the student requires additional, previously not provided, related services (e.g., language therapy, etc.) or an increase in related services
  • To determine whether a student might benefit from an application of a particular therapy technique or program (e.g, Orton-Gillingham)
  • To determine whether a student with a severe impairment (e.g., severe emotional and behavioral disturbances, genetic syndrome, significant intellectual disability, etc.) is a good candidate for an out of district specialized school

Why can’t similar assessments be performed in school settings?

There are several reasons for that.

Why are IEE’s Needed?

The answer to that is simple:  “To strengthen the role of parents in the educational decision-making process.” According to one Disability Rights site: “Many disagreements between parents and school staff concerning IEP services and placement involve, at some stage, the interpretation of evaluation findings and recommendations. When disagreements occur, the Independent Educational Evaluation (IEE) is one option lawmakers make available to parents, to help answer questions about appropriate special education services and placement“.

Indeed, many of the clients who retain my services also retain the services of educational advocates as well as special education lawyers.  Many of them work on determining appropriate level of services as well as an out of district placement for the children with a variety of special education needs. However, one interesting reoccurring phenomenon I’ve noted over the years is that only a small percentage of special education lawyers, educational advocates, and even parents believed that children with autism spectrum disorders, genetic syndromes, social pragmatic deficits, emotional disturbances, or reading disabilities required a comprehensive language evaluation/reevaluation prior to determining an appropriate out of district placement or an in-district change of service provision.

So today I would like to make a case, in favor of comprehensive independent language evaluations being a routine component of every special education dispute involving a child with impaired academic performance. I will do so through the illustration of past case scenarios that clearly show that comprehensive independent language evaluations do matter, even when it doesn’t look like they may be needed.

Case A: “He is just a weak student”.

Several years ago I was contacted by a parent of a 12 year old boy, who was concerned with his son’s continuously failing academic performance. The child had not qualified for an IEP but was receiving 504 plan in school setting and was reported to significantly struggle due to continuous increase of academic demands with each passing school year.  An in-district language evaluation had been preformed several years prior. It showed that the student’s general language abilities were in the low average range of functioning due to which he did not qualify for speech language services in school setting. However, based on the review of available records it very quickly became apparent that many of the academic areas in which the student struggled (e.g., reading comprehension, social pragmatic ability, critical thinking skills, etc)  were simply not assessed by the general language testing. I had suggested to the parent a comprehensive language evaluation and explained to him on what grounds I was recommending this course of action.  That comprehensive 4 hour assessment broken into several testing sessions revealed that the student presented with severe receptive, expressive, problem solving and social pragmatic language deficits, as well as moderate executive function deficits, which required therapeutic intervention.

Prior to that assessment the parent, reinforced by the feedback from his child’s educational staff believed his son to be an unmotivated student who failed to apply himself in school setting.  However, after the completion of that assessment, the parent clearly understood that it wasn’t his child’s lack of motivation which was impeding his academic performance but rather a true learning disability was making it very difficult for his son to learn without the necessary related services and support. Several months after the appropriate related services were made available to the child in school setting on the basis of the performed IEE, the parent reported significant progress in his child academic performance.

Case B: “She’s just not learning because of her behavior, so there’s nothing we can do”.  

This case involved a six year old girl who presented with a severe speech – language disorder and behavioral deficits in school setting secondary to an intellectual disability of an unspecified origin.

In contrast to Case A scenario, this child had received a variety of assessments and therapies since a very early age; however, her parents were becoming significantly concerned regarding her regression of academic functioning in school setting and felt that a more specialized out of district program with a focus on multiple disabilities would be better suitable to her needs. Unfortunately the school disagreed with them and believed that she could be successfully educated in an in-district setting (despite evidence to the contrary).  Interestingly, an in-depth comprehensive speech language assessment had never been performed on this child because her functioning was considered to be “too low” for such an assessment.

Comprehensive assessment of this little girl’s abilities revealed that via an application of a variety of behavioral management techniques (of non-ABA origin), and highly structured language input, she was indeed capable of significantly better performance then she had exhibited in school setting.  It stood to reason that if she were placed in a specialized school setting composed of educational professionals who were trained in dealing with her complex behavioral and communication needs, her performance would continue to steadily improve.  Indeed, six months following a transfer in schools her parents reported a “drastic” change pertaining to a significant reduction in challenging behavioral manifestations as well as significant increase in her linguistic output.

Case C: “Your child can only learn so much because of his genetic syndrome”.  

This case scenario does not technically involve just one child but rather three different male students between 9 and 11 years of age with several ‘common’ genetic syndromes: Down, Fragile X, and Klinefelter.  All three were different ages, came from completely different school districts, and were seen by me in different calendar years.

However, all three boys had one thing in common, because of their genetic syndromes, which were marked by varying degrees of intellectual disability as well as speech language weaknesses, their parents were collectively told that there could be very little done for them with regards to expanding their expressive language as well as literacy development.

Similarly to the above scenarios, none of the children had undergone comprehensive language testing to determine their strengths, weaknesses, and learning styles. Comprehensive assessment of each student revealed that each had the potential to improve their expressive abilities to speak in compound and complex sentences. Dynamic assessment of literacy also revealed that it was possible to teach each of them how to read.

Following the respective assessments, some of these students had became my private clients, while others’s parents have periodically written to me, detailing their children’s successes over the years.  Each parent had conveyed to me how “life-changing”a comprehensive IEE was to their child.

Case D: “Their behavior is just out of control”

The final case scenario I would like to discuss today involves several students with an educational classification of “Emotionally Disturbed” (pg 71).  Those of you who are familiar with my blog and my work know that my main area of specialty is working with school age students with psychiatric impairments and emotional behavioral disturbances.  There are a number of reasons why I work with this challenging pediatric population. One very important reason is that these students continue to be grossly underserved in school setting. Over the years I have written a variety of articles and blog posts citing a number of research studies, which found that a significant number of students with psychiatric impairments and emotional behavioral disturbances present with undiagnosed linguistic impairments (especially in the area of social communication), which adversely impact their school-based performance.

Here, we are not talking about two or three students rather we’re talking about the numbers in the double digits of students with psychiatric impairments and emotional disturbances, who did not receive appropriate therapies in their respective school settings.

The majority of these students were divided into two distinct categories. In the first category, students began to manifest moderate-to-severe speech language deficits from a very early age. They were classified in preschool and began receiving speech language therapy. However by early elementary age their general language abilities were found to be within the average range of functioning and their language therapies were discontinued.   Unfortunately since general language testing does not assess all categories of linguistic functioning such as critical thinking, executive functions, social communication etc., these students continued to present with hidden linguistic impairments, which continued to adversely impact their behavior.

Students in the second category also began displaying emotional and behavioral challenges from a very early age. However, in contrast to the students in the first category the initial language testing found their general language abilities to be within the average range of functioning. As a result these students never received any language-based therapies and similar to the students in the first category, their hidden linguistic impairments continued to adversely impact their behavior.

Students in both categories ended up following a very similar pattern of behavior. Their behavioral challenges in the school continued to escalate. These were followed by a series of suspensions, out of district placements, myriad of psychiatric and neuropsychological evaluations, until many were placed on home instruction. The one vital element missing from all of these students’ case records were comprehensive language evaluations with an emphasis on assessing their critical thinking, executive functions and social communication abilities. Their worsening patterns of functioning were viewed as “severe misbehaving” without anyone suspecting that their hidden language deficits were a huge contributing factor to their maladaptive behaviors in school setting.

Conclusion:

So there you have it!  As promised, I’ve used four vastly different scenarios that show you the importance of comprehensive language evaluations in situations where it was not so readily apparent that they were needed.  I hope that parents and professionals alike will find this post helpful in reconsidering the need for comprehensive independent evaluations for students presenting with impaired academic performance.

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Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts

FullSizeRender (3)In the past a number of my SLP colleague bloggers (Communication Station, Twin Sisters SLPs, Practical AAC, etc.) wrote posts regarding the use of thematic texts for language intervention purposes. They discussed implementation of fictional texts such as the use of children’s books and fairy tales to target linguistic goals such as vocabulary knowledge in use, sentence formulation, answering WH questions, as well as story recall and production.

Today I would like to supplement those posts with information regarding the implementation of intervention based on thematic nonfiction texts to further improve language abilities of children with language difficulties.

First, here’s why the use of nonfiction texts in language intervention is important. While narrative texts have high familiarity for children due to preexisting, background knowledge, familiar vocabulary, repetitive themes, etc. nonfiction texts are far more difficult to comprehend. It typically contains unknown concepts and vocabulary, which is then used in the text multiple times. Therefore lack of knowledge of these concepts and related vocabulary will result in lack of text comprehension. According to Duke (2013) half of all the primary read-alouds should be informational text. It will allow students to build up knowledge and the necessary academic vocabulary to effectively participate and partake from the curriculum.

So what type of nonfiction materials can be used for language intervention purposes. While there is a rich variety of sources available, I have had great success using Let’s Read and Find Out Stage 1 and 2 Science Series with clients with varying degrees of language impairment.

Here’s are just a few reasons why I like to use this series.

  • They can be implemented by parents and professionals alike for different purposes with equal effectiveness.
  • They can be implemented with children fairly early beginning with preschool on-wards 
  • The can be used with the following pediatric populations:
    • Language Disordered Children
    • Children with learning disabilities and low IQ
    • Children with developmental disorders and genetic syndromes (Fragile X, Down Syndrome, Autism, etc.)
    • Children with Fetal Alcohol Spectrum Disorders
    • Internationally adopted children with language impairment
    • Bilingual children with language impairment
    • Children with dyslexia and reading disabilities
    • Children with psychiatric Impairments
  • The books are readily available online (Barnes & Noble, Amazon, etc.) and in stores.
  • They are relatively inexpensive (individual books cost about $5-6).
  • Parents or professionals who want to continuously use them seasonally can purchase them in bulk at a significantly cheaper price from select distributors (Source: rainbowresource.com)
  • They are highly thematic, contain terrific visual support, and are surprisingly versatile, with information on topics ranging from animal habitats and life cycles to natural disasters and space.
  • They contain subject-relevant vocabulary words that the students are likely to use in the future over and over again (Stahl & Fairbanks, 1986).
  • The words are already pre-grouped in semantic clusters which create schemes (mental representations) for the students (Marzano & Marzano, 1988).

For example, the above books on weather and seasons contain information  on:

1. Front Formations
2. Water Cycle
3. High & Low Pressure Systems

Let’s look at the vocabulary words from Flash, Crash, Rumble, and Roll  (see detailed lesson plan HERE). (Source: ReadWorks):

Word: water vapor
Context: Steam from a hot soup is water vapor.

Word: expands
Context: The hot air expands and pops the balloon.

Word: atmosphere
Context:  The atmosphere is the air that covers the Earth.

Word: forecast
Context: The forecast had a lot to tell us about the storm.

Word: condense
Context: steam in the air condenses to form water drops.

These books are not just great for increasing academic vocabulary knowledge and use. They are great for teaching sequencing skills (e.g., life cycles), critical thinking skills (e.g., What do animals need to do in the winter to survive?), compare and contrast skills (e.g., what is the difference between hatching and molting?) and much, much, more!

So why is use of nonfiction texts important for strengthening vocabulary knowledge and words in language impaired children?

As I noted in my previous post on effective vocabulary instruction (HERE): “teachers with many struggling children often significantly reduce the quality of their own vocabulary unconsciously to ensure understanding” (Excerpts from Anita Archer’s Interview with Advance for SLPs).  

The same goes for SLPs and parents. Many of them are under misperception that if they teach complex subject-related words like “metamorphosis” or “vaporization” to children with significant language impairments or developmental disabilities that these students will not understand them and will not benefit from learning them.

However, that is not the case! These students will still significantly benefit from learning these words, it will simply take them longer periods of practice to retain them!

By simplifying our explanations, minimizing verbiage and emphasizing the visuals, the books can be successfully adapted for use with children with severe language impairments.  I have had parents observe my intervention sessions using these books and then successfully use them in the home with their children by reviewing the information and reinforcing newly learned vocabulary knowledge.

Here are just a few examples of prompts I use in treatment with more severely affected language-impaired children:

  • —What do you see in this picture?
  • —This is a _____ Can you say _____
  • What do you know about _____?
  • —What do you think is happening? Why?
  • What do you think they are doing? Why?
  • —Let’s make up a sentence with __________ (this word)
  • —You can say ____ or you can say ______ (teaching synonyms)
  • —What would be the opposite of _______? (teaching antonyms)
  • — Do you know that _____(this word) has 2 meanings
    • —1st meaning
    • —2nd meaning
  • How do ____ and _____ go together?

Here are the questions related to Sequencing of Processes (Life Cycle, Water Cycle, etc.)

  • —What happened first?
  • —What happened second?
  • —What happened next?
  • —What happened after that?
  • —What happened last?

As the child advances his/her skills I attempt to engage them in more complex book interactions—

  • —Compare and contrast items
  • — (e.g. objects/people/animals)
  • —Make predictions and inferences about will happen next?
  • Why is this book important?

“Picture walks” (flipping through the pages) of these books are also surprisingly effective for activation of the student’s background knowledge (what a student already knows about a subject). This is an important prerequisite skill needed for continued acquisition of new knowledge. It is important because  “students who lack sufficient background knowledge or are unable to activate it may struggle to access, participate, and progress through the general curriculum” (Stangman, Hall & Meyer, 2004).

These book allow for :

1.Learning vocabulary words in context embedded texts with high interest visuals

2.Teaching specific content related vocabulary words directly to comprehend classroom-specific work

3.Providing multiple and repetitive exposures of vocabulary words in texts

4. Maximizing multisensory intervention when learning vocabulary to maximize gains (visual, auditory, tactile via related projects, etc.)

To summarize, children with significant language impairment often suffer from the Matthew Effect (—“rich get richer, poor get poorer”), or interactions with the environment exaggerate individual differences over time

Children with good vocabulary knowledge learn more words and gain further knowledge by building of these words

Children with poor vocabulary knowledge learn less words and widen the gap between self and peers over time due to their inability to effectively meet the ever increasing academic effects of the classroom. The vocabulary problems of students who enter school with poorer limited vocabularies only worsen over time (White, Graves & Slater, 1990). We need to provide these children with all the feasible opportunities to narrow this gap and partake from the curriculum in a more similar fashion as typically developing peers. 

Helpful Smart Speech Therapy Resources:

References:

Duke, N. K. (2013). Starting out: Practices to Use in K-3. Educational Leadership, 71, 40-44.

Marzano, R. J., & Marzano, J. (1988). Toward a cognitive theory of commitment and its implications for therapy. Psychotherapy in Private Practice 6(4), 69–81.

Stahl, S. A. & Fairbanks, M. M. “The Effects of Vocabulary Instruction: A Model-based Metaanalysis.” Review of Educational Research 56 (1986): 72-110.

Strangman, N., Hall, T., & Meyer, A. (2004). Background knowledge with UDL. Wakefield, MA: National Center on Accessing the General Curriculum.

White, T. G., Graves, M. F., & Slater W. H. (1990). Growth of reading vocabulary in diverse elementary schools: Decoding and word meaning. Journal of Educational Psychology, 82, 281–290.

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Dear School Professionals Please Be Aware of This

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I frequently get  emails,  phone calls,  and questions from parents and professionals  regarding academic functioning of internationally adopted post institutionalized children.  Unfortunately despite the fact that  there is  a  fairly large body of research  on this topic  there still continue to be numerous misconceptions regarding how these children’s needs should be addressed  in academic settings.

Perhaps  one of the most serious and damaging misconceptions is that internationally adopted children are bilingual/multicultural children with Limited English Proficiency who need to be treated as ESL speakers. This erroneous belief often leads to denial or mismanagement of appropriate level of services for these children not only with respect to their  language processing and verbal expression but also their social pragmatic language abilities.

Even after researchers published a number of articles on this topic, many psychologists, teachers and speech language pathologists still don’t know that internationally adopted children rapidly lose their little birth language literally months post their adoption by English-speaking parents/families. Gindis (2005) found that children adopted between 4-7 years of age lose expressive birth language abilities within 2-3 months and receptive abilities within 3-6 months post- adoption. This process is further expedited in children under 4, whose language is delayed or impaired at the time of adoption (Gindis, 2008).    Even school-aged children of 10-12 years of age who were able to read and write in their birth language,  rapidly lose  their comprehension and expression of birth language  within their first year post adoption,  if adopted by English-speaking parents who are unable to support their birth language.

 So how does this translate into appropriate provision of speech language services you may ask?   To begin with,  I often see posts on the ASHA forums  or in Facebook speech pathology and special education groups seeking assistance with finding interpreters fluent in various exotic languages.  However, unless the child is “fresh off the boat” (several months post arrival to US)  schools shouldn’t be feverishly trying to locate interpreters to assist with testing in the child’s birth language.  They will not be able to obtain any viable results especially if the child had been residing in the United States for several years.

So if the post-institutionalized, internationally  adopted child is still struggling with academics  several years post adoption,  one should not immediately jump to the conclusion that this is an “ESL” issue,  but get relevant professionals (e.g., speech pathologists, psychologists) to perform thorough testing in order to determine whether it’s the lack of foundational abilities due to institutionalization which is adversely impacting the child’s academic abilities.

Furthermore, ESL itself is often not applicable as an educational method to internationally adopted children.  Here’s why:

Let’s literally take the first definition of ESL which pops-up on Google when you put in a query: “What is ESL?”  “English as a Second Language (ESL) is an instructional program for students whose dominant language is not English. The purpose of the program is to increase the English language proficiency of eligible students so they can attain academic standards and achieve success in the classroom.”

Here is our first problem.  These students don’t have a dominant language.   They are typically adopted by parents who do not speak their birth language and that are unable to support them in their birth language. So upon arrival to US, IA children will typically acquire English via the subtractive model of language acquisition (birth language is replaced and eliminated by English), which is a direct contrast to bilingual children, many of whom learn via the additive model (adding English to the birth language (Gindis, 2005). As a result, of subtractive language acquisition IA children experience very rapid birth language attrition (loss) post-adoption (Gindis, 2003; Glennen, 2009).   Thus they will literally undergo what some researchers have called: “second-first language acquisition” (Scott et al., 2011)  and their first language will “become completely obsolete as English is learned” (Nelson, 2012, p. 2). 

This brings us to our second problem: the question of “eligibility”.  Historically, ESL programs have been designed to assist children of immigrant families  acquire academic readiness skills.  This methodology is based on the fact that skills from first language was ultimately transfer to the  second language.  However, since post-institutionalized children don’t technically have a “first language”  and  their home language is English,  how could they technically be eligible for ESL services? Furthermore,  because of frequent lack of basic foundational skills in the birth language  internationally adopted post-institutionalized children will not benefit the same way from ESL instruction the same way bilingual children of immigrant families do.  So instead of focusing on these children’s questionable eligibility for ESL services  it is important to perform detailed review of their pre-adoption records in order to determine birth language deficits and consider eligibility for  speech language services with the emphasis on improving  these children’s  foundational skills.

If the child’s pre-adoption records specifically state that s/he has birth language delay then it should be taken seriously (Gindis, 1999) since language delays in the birth language transfer and affect the new language (McLaughlin, Gesi, & Osani, 1995). These delays will not “go away” without appropriate interventions.  “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)

Now that we have discussed the issue of ESL services, lets touch upon social pragmatic language abilities of internationally adopted children.  Here’s how erroneous beliefs can contribute to mismanagement of appropriate services in this area.

Different cultures have different pragmatic conventions,  therefore we are taught to be very careful when labeling  certain behaviors  of children from other cultures as atypical, just because they are not consistent with the conventions and behaviors of children from the mainstream culture. Here’s a recent example. A mainstream American parent consulted an SLP regarding the inappropriate social pragmatic skills of her teenaged daughter adopted almost a decade ago from Southeast Asia. The SLP was under the  impression that  some of the child’s deficits  were due to multicultural differences and had to do with the customs and traditions of the child’s country of origin. She was considering  advising the parent regarding requesting  an evaluation by a SLP who spoke the child’s birth language.

Here are two problems with the above scenario.  Firstly,  any internationally adopted post-institutionalized child who was adopted by American parents who were not part of the culture from which the child was adopted, the child will quickly become acculturated  and  immersed in the American culture.  These children “need functional English for survival”, and thus have a powerful incentive to acquire English (Gindis, 2005; p. 299).   consequently, any unusual or atypical behaviors they exhibit in social interactions and in academic setting with other individuals cannot be  attributed to customs and traditions of another culture.

Secondly,  It is very important to understand that  institutionalization and orphanage care have been closely linked to increase in mental health disorders  and psychiatric impairments.   As a result, internationally adopted children have a high incidence of social pragmatic deficits as compared to non-adopted peers as well as post-institutionalized children adopted at younger ages, (under 3).    Given this, if parents present with concerns regarding their internationally adopted post-institutionalized children’s social pragmatic and behavioral functioning it is very important not to  jump to erroneous conclusion pertaining to these children’s birth countries but rather preform comprehensive evaluations in order to determine whether these children can be assisted further in the realm of social pragmatic functioning in a variety of settings.

In order to develop a clear picture regarding appropriate service delivery for IA children, school based professionals need to educate themselves regarding the fundamental differences between development and learning trajectories of internationally adopted children and multicultural/bilingual children. Children, who struggle academically, after years of adequate schooling exposure, do not deserve a “wait and see” approach. They should start receiving appropriate intervention as soon as possible (Hough & Kaczmarek, 2011; Scott & Roberts, 2007).

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Dear Pediatrician: Please Don’t Say That!

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Recently, a new client came in for therapy.  He was a little over three years of age with limited verbal abilities,  and a number of stereotypical behaviors consistent with autism spectrum disorder.  During the course of parental interview, the child’s mother mentioned that he had previously briefly received early intervention services  but  aged out from the early intervention system after only a few months.  As we continued to discuss the case, his mother revealed that she  had significant concerns regarding her son’s language abilities and behavior from a very early age  because it  significantly differed from his older sister’s developmental trajectory. However,  every time she brought it up to her pediatrician  she invariably received the following answers:  “Don’t compare him to his sister, they are different  children”  and   “Don’t  worry,  he will catch up”,  which resulted in the child being referred for early intervention services when he was almost 3 years of age,  and unable to receive consistent  speech therapy services prior to aging out of the program all together.

This is not the first time I heard such a story,  and I’m sure it won’t be the last time as well.  Sadly, myself and other speech language therapists are very familiar with such cases and that is such a shame.  It is a shame, because  a parent was absolutely correct in trusting her instincts but was not validated by a medical professional she trusted the most, her child’s pediatrician.  Please don’t get me wrong,  I am not  playing the blame game  or trying to denigrate members of another profession.   My  aim  today is rather different and that is along with my colleagues to continue increasing awareness among all health professionals  regarding the early identification  of communication disorders  in children in order for them to receive  effective early intervention services  to improve their long-term outcomes.

getty_rf_photo_of_toddler_feeding_teddy_bear

 Whenever one “Googles” the term “Language Milestones In Children”  or “When  do children begin to talk?”   Numerous links pop-up,  describing developmental milestones in children.  Most of them contain  fairly typical information such as: first word emerge at approximately 12 months of age,   2 word combinations emerge when the child has a lexicon of approximately 50 words or more, which corresponds  to  a period between  18 months to 2 years of age,  and sentences emerge when a child is approximately 3 years of age. While most of this information is hopefully common knowledge for many healthcare professionals working with children including pediatricians,  is also important to understand that when the child comes in for a checkup one should not look at these abilities in isolation but  rather  look at the child  holistically.  That means  asking the parents the right questions to compare the child’s cognitive, adaptive,  social emotional, as well as communicative functioning  to that of typically developing peers  or siblings  in order to determine whether anything is amiss.  Thus, rather than to discourage the  parent  from  comparing their child to typically developing children his age, the parents  should actually be routinely asked the variation of the following question: “How  do your child’s abilities  and functioning compare to other typically developing children your child age?”

woman-talking-to-doctorWhenever I ask this question during the process of evaluation or initiation of therapy  services,  90% of the time I receive highly detailed and intuitive responses  from well-informed parents. They immediately begin describing in significant detail the difference in functioning  between their own delayed child  and  his/her  siblings/peers.   That is why in the majority of cases  I find the background information provided by the parent to be almost as valuable  as the evaluation itself.  For example, I recently assessed  a 3-5 year-old child  due to communication concerns.   The pediatrician was very reluctant to refer to the child for services due to the fact that the child was adequately verbal.   However,  the child’s  parents were insistent,  a script for services was written, and the child was brought to me for an evaluation.  Parents reported that while their child was very verbal and outgoing,  most of the time they had significant difficulty  understanding what she was trying to tell them due to poor grammar as well as nonsensical content of her messages.   They also reported that the child had a brother , who was older than her last several years.  However,  they stated that they had never experienced similar difficulties with the child’s brother when he was her age,  which is why they became so concerned with each passing day regarding the child’s language abilities.

Indeed, almost  as soon as the evaluation began, it became apparent that while the child’s verbal output was adequate, the semantic content of those messages  as well as the pragmatic use in conversational exchanges  was significantly impaired. In  other words,  the  child may have been adequately verbose but  the coherence of her discourse left a lot to be desired.   This child was the perfect candidate for therapy but had parents not insisted, the extent of her expressive language difficulties  may have been overlooked until she was old enough to go to kindergarten. By then  many valuable intervention  hours would have been lost  and the extent of the child deficits have been far greater.

So dear pediatrician,  the next time  a concerned parent utters the words: “I think something is wrong…” or “His language is nothing like his brother’s/sister’s when s/he was that age” don’t be so hasty in dismissing their concerns. Listen to them,  understand that while you are the expert in childhood health and diseases,   they are  the expert  in their own child,  and are highly attuned  to their child’s functioning and overall abilities. Encourage them to disclose their worries by asking follow-up questions and validating their concerns.

why_your_doctor_needs_to_know_your_life_story_4461_98044748There are significant benefits  to receiving early targeted  care  beyond the improvement in language abilities.  These include but are not limited to:  reduced chances of behavioral deficits or mental illness, reduced chances of reading, writing and learning difficulties  when older,  reduced chances of  impaired socialization abilities and self-esteem,  all of which can affect children with language deficits when appropriate services are delayed or never provided.  So please, err on the side of caution  and refer the children with suspected deficits to speech language pathologists.  Please give us an opportunity to thoroughly assess these children in order to find out  whether there truly is  speech/language disorder/delay.  Because by doing this you truly will be serving the interests of your clients.

Helpful Smart Speech Therapy Resources:

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Pediatric Background History Questionnaire Giveaway

peds questionnaireToday I am very excited to introduce my new product “Pediatric Background History Questionnaire”. I’ve been blogging quite a bit lately on the topic of obtaining a thorough developmental client history in order to make an appropriate and accurate diagnosis of the child’s difficulties for relevant classroom placement, appropriate accommodations and modifications as well as targeted and relevant therapeutic services.  
Continue reading Pediatric Background History Questionnaire Giveaway

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What is ND-PAE and how is it Related to FASD?

The DSM-5 was released in May 2013 and with it came a revision of criteria for the diagnosis and classification of many psychiatric disorders.  Among them a new proposed criteria was included relevant to alcohol related deficits in children, which is Neurobehavioral Disorder Associated  With Prenatal Alcohol Exposure (ND-PAE) (DSM-5, pgs 798-801). This proposed criteria was included in order to better serve the complex mental health needs of individuals diagnosed with alcohol related deficits, which the previous diagnosis of 760.71 – Alcohol affecting fetus or newborn via placenta or breast milk was unable to adequately capture.   Continue reading What is ND-PAE and how is it Related to FASD?

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Why Developmental History Matters: On the Importance of Background Information in Speech-Language Assessments

Cute Detective Clip ArtLately I’ve been seeing quite a few speech language therapy reports with minimal information about the child in the background history section of the report. Similarly, I’ve encountered numerous SLPs seeking advice and guidance relevant to the assessment and treatment of difficult cases who were often at a loss when asked about specific aspects of their client’s background family history in order to assist them better. They’ve never delved into it beyond a few surface details! Continue reading Why Developmental History Matters: On the Importance of Background Information in Speech-Language Assessments

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Winter Non-Fiction Leveled Reading Passages and Questions Product Swap and Giveaway

Today I am doing a product swap and giveaway with Sharon Schackmann, the author of the Speech with Sharon blog, who’s created a product entitled: Winter Non-Fiction Leveled Reading Passages and Questions with a focus on teaching non-fiction text to older students: elementary through -high school ages.

This mega sized 44 page packet includes 7 passages on a variety of winter related topics including: Continue reading Winter Non-Fiction Leveled Reading Passages and Questions Product Swap and Giveaway